This project addresses concerns that the location of primary care at the hospital will increase costs. The project will analyze differences in amounts and kinds of resources (i.e., input intensity) used in treating defined episodes of tracer conditions (controlled case mix) in hospital and non hospital based primary care settings. Overall intensity will be measured by aggregating utilization data on medical visits, lab/x-ray procedures, and drugs provided for each defined episode condition using the Cal. RVS. The hypotheses are that primary care intensity per defined episode will be greater in the hospital setting, and that physical location of care at the hospital will contribute to the hospital effect through resource availability and acute care orientation processes. The project also will evaluate whether intensity is associated with care outcomes, measured by later utilization indicative of non successful treatment. The hypothesis is that lower intensity care will not be systematically associated with poorer care outcomes. As now planned, the study population will consist of subscribers to the Kaiser Foundation Health Plan in Portland Ore. Primary care provided at Bess Kaiser Hopital, and at the five outlying clinics, will be compared. The 5 percent random sample of subscriber units maintained by the Research Center will be used, drawing on the ongoing Medical Care Utilization Study. To address generalizing from the prepaid system, and from the settings studied to others, the project will include an analysis of generalizability. Using data internal to the Kaiser system, data from 1-2 other primary care settings, and available research and knowledge, the analysis will focus on differences in organization and incentives between studied and unstudied settings, and their expected direction of effect.